Access assembly

ABSTRACT

A surgical access assembly including a base and an elongated member extending from the base. The base defines a central axis and has an opening for receipt of a surgical instrument. The elongated member defines a passageway for passage of at least a portion of the surgical instrument and is adapted to assume a substantially rolled configuration in a normal unstressed condition thereof. When in the rolled configuration, the elongated member is rolled transverse to the central axis.

CROSS REFERENCE TO RELATED APPLICATIONS

The present application is a continuation application of U.S. patentapplication Ser. No. 13/751,553, filed on Jan. 28, 2013, which is acontinuation of U.S. patent application Ser. No. 12/467,433, filed onMay 18, 2009, now U.S. Pat. No. 8,403,889, which claims the benefit ofand priority to U.S. Provisional Patent Application Ser. No. 61/075,521,filed on Jun. 25, 2008, the entire disclosure of each application, isincorporated herein by reference.

BACKGROUND

1. Technical Field

The present disclosure relates to assemblies for accessing a bodycavity, and more particularly, to an access assembly having a lowprofile.

2. Background of Related Art

Trocars and other access assemblies are used by surgeons to operate on apatient without having to create large incisions that may becomeinfected and may cause major scaring. Access assemblies are known in theart, as are the instruments inserted therethrough for operating withinthe body cavity. Typically, an access assembly includes a housing, and atubular member or cannula affixed to the housing and configured forinsertion into a body cavity. These assemblies generally include a zeroclosure seal mounted within the housing to prevent the escape ofinsufflation gas and an instrument seal also within the housing forforming a seal about the instrument.

The cannula of conventional access assemblies are limited in that theyreduce the type and configuration of instruments that may be insertedinto a body cavity. A curved or otherwise bent instrument may not beinserted through a conventional cannula. In addition, manipulation ofthe inserted instrument is limited by the dimensioning of the cannula.Even further, the housing and a conventional cannula incorporates boththe instrument and zero closure seal, and, as a result, presents arelatively large profile encompassing a significantly larger area withinthe operative field.

Therefore, it would be beneficial to have an access assembly including alow profile housing and capable of permitting offset manipulation of theinstrument.

SUMMARY

In accordance with one embodiment of the present disclosure, a surgicalaccess assembly includes a base defining a central axis and having anopening for receipt of a surgical instrument and an elongated memberextending from the base. The elongated member may define a passage forpassage of the surgical instrument. The elongated member is adapted toassume a substantial rolled configuration in a normal unstressedcondition thereof. The elongated member may be adapted to substantiallyseal the passage when in the rolled configuration thereof. As a furtherfeature, the elongated member may be adapted to establish a substantialsealed relation with the surgical instrument received within thepassage. In one embodiment, the elongated member may include anelastomeric material which is adapted to permit angulated movement ofthe surgical instrument relative to the central axis. The elongatedmember may include a leading end portion which is substantially closedin the absence of the surgical instrument to substantially seal thepassage.

The elongated member may include a coating for facilitating theinsertion and removal of an endoscopic instrument, and is configured toreceive endoscopic instruments of varying diameters. The elongatedmember may be configured to receive a endoscopic instrument having acurved length.

The base may include an adhesive ring for selectively sealing the baseto a patient. In the alternative, the base may include one or moresuture tie down members. The suture tie down members each may include arecess formed about the perimeter of the base. Alternatively, the suturetie down members may include tabs extending from the perimeter of thebase. The base may include a substantially disc-shaped member having alow profile, and may be devoid of a seal.

BRIEF DESCRIPTION OF THE DRAWINGS

The foregoing summary, as well as the following detailed descriptionwill be better understood when read in conjunction with the appendedfigures. For the purpose of illustrating the present disclosure, apreferred embodiment is shown. It is understood, however, that thepresent disclosure is not limited to the precise arrangement andinstrumentalities shown.

FIG. 1 is a side view of an access assembly according to aspects of thepresent disclosure in an initial or pre-stretched and rolled condition;

FIG. 2 is a side view of the access assembly of FIG. 1 in a stretchedand extended condition;

FIG. 3 is a top view of the access assembly of FIGS. 1 and 2;

FIG. 4 is a cross-sectional view of the access assembly of FIGS. 1-3taken along line 4-4 of FIG. 1;

FIG. 5 is a side view of the access assembly of FIGS. 1-4 illustratingan endoscopic instrument positioned within the access assembly;

FIG. 6 is a side view of the access assembly of FIGS. 1-5 illustratingthe endoscopic instrument manipulated within the access assembly;

FIG. 7 is a side view of the access assembly of FIGS. 1-6 illustrating acurved endoscopic instrument positioned within the access assembly;

FIG. 8 is a side cross-sectional view of an alternate embodiment of anaccess assembly according to the present disclosure;

FIG. 9 is a top view of the access assembly of FIG. 8; and

FIG. 10 is side view of the access assembly of FIGS. 8 and 9illustrating an endoscopic instrument positioned within the accessassembly.

DETAILED DESCRIPTION

Referring now to the drawings wherein like reference numerals illustratesimilar components throughout the several views. As shown in thedrawings and as described throughout the following description, as istraditional, when referring to relative positioning on an object, theterm “proximal” refers to the end of the apparatus which is closer tothe user and the term “distal” refers to the end of the apparatus whichis further from the user.

With reference to FIGS. 1-5, an embodiment of an access assembly inaccordance with the aspects of the present disclosure is shown generallyas access assembly 100. Access assembly 100 includes base 102 andelongated member 110 extending from the base 102 and defining alongitudinal axis “y”. Access assembly 100 defines a longitudinalpassageway 101 extending through the base 102 and elongated member 110,and is adapted for receiving an endoscopic instrument.

Base 102 of access assembly 100 may define a substantially flat circularmember having proximal and distal surfaces 102 a, 102 b. Base 102includes opening 103 which forms part of longitudinal passageway 101.Base 102 is constructed of plastic, metal or any other suitablematerial. As will be discussed in further detail below, base 102 issecured to elongated member 110. Base 102 may include an adhesive ring104 circumscribing opening 103 on distal surface 102 b. Adhesive ring104 may be adapted to selectively secure base 102 to a patient during anendoscopic procedure. Adhesive ring 104 may include any biocompatibleadhesive suitable for selectively affixing base 102 to a patient.Adhesive ring 104 may form a seal between the patient and base 102 toprevent the escape of insufflation gas from within the cavity of thepatient. It is envisioned, however, that distal surface 102 b of base102 may include a second ring (not shown) configured to form a sealbetween base 102 and the patient.

Elongated member 110 includes a flexible tapered sleeve 111 havingsubstantially open proximal end 110 a, and distal end 110 b which iscapable of assuming an open or closed position in the presence orabsence of a surgical instrument, respectively. Tapered sleeve 111 issubstantially tapered along a length thereof. Proximal end 110 a issecurely affixed to distal surface 102 b of base 102 in any suitablemanner, including, but not limited to, welding, adhesives and mechanicalfasteners. Elongated member 110 is constructed from an elastomericmaterial that is capable of stretching to receive an endoscopicinstrument therethrough. In one embodiment, elongated member 110 mayinclude a tubular fabric coated or impregnated with an elastomericmaterial. This arrangement is disclosed in commonly assigned U.S. patentapplication Ser. No. 10/967,056, filed Oct. 15, 2004, the entirecontents of which is incorporated herein by reference. Elongated member110 may be fabricated from any material which is capable of receiving asurgical instrument “I” and radially expanding to permit passage of thesurgical instrument “I” in sealed relation. Some suitable materialsinclude medical grade polymers and metals. In an exemplary embodiment,elongated member 110 includes a braided material of inelastic filamentscovered by an elastomeric membrane of, e.g., urethane, or anyelastomeric material or as generally disclosed in commonly assigned U.S.Pat. Nos. 5,431,676 and 6,245,052, the entire contents of each beingincorporated herein by reference. Elongated member 110 is adapted toform a seal about the endoscopic instrument to substantially prevent theegress or release of insufflation gases or fluids about the instrument.Elongated seal member 110 may receive instruments of different andvarying diameters and/or instruments having curved or bent lengths. Dueto its resilient characteristics, elongated member 110 further permitsgreater manipulation of endoscopic instrument “I” within the elongatedmember 110 providing a large degree of off-axis or angulated movement ofthe instrument relative to conventional inflexible cannulas.

With particular reference to FIG. 1, in an initial or pre-stretchedcondition, elongated member 110 defines a rolled or spiraledconfiguration about an axis “z” that is transverse to longitudinal axis“y”. This arrangement may assist in establishing a seal withinlongitudinal passageway 101 of access member 100. In addition, distalend 110 b of elongated member 110 may be adapted to form a zero closureseal, such that in the absence of an endoscopic instrument, distal end110 b is sealed. Thus, the spiraled or rolled configuration of elongatedmember 110, in conjunction with the ability of distal end 110 b toclose, provides a substantial seal within access assembly 100 whenaccess assembly 100 is not in use receiving an endoscopic instrument andincreases the integrity of the seal defined within access assembly 100.Alternatively, distal end 110 b of elongated member 110 may be partiallyopen, whereby the rolling of elongated member 110 establishes the sealwithin access assembly 100. FIG. 2 illustrates elongated member 111 inthe stretched or unrolled position which is assumed upon introduction ofthe surgical instrument. This rolled configuration may be preset duringmanufacture, e.g., set in the rolled configuration during curing of theelastomer. In the alternative, elongated member 110 may be a shapememory material adapted to assume the rolled configuration upon exposureto a predefined temperature, e.g. body temperature. Such shape memorymaterials capable of performing in this manner are appreciated by oneskilled in the art.

Elongated member 110 thus can serve as both the zero closure seal andthe instrument seal for access assembly 100, and removes the necessityof positioning these seals within housing or base 102. As a consequence,base 102 may be reduced in height. This reduced height or profile willincrease the operating area available above the patient to improveinstrument maneuverability, thereby potentially facilitating completionof the surgical procedure.

Access assembly 100 will be discussed in the terms of use of theassembly 100 in a laparoscopic surgery. The abdominal cavity isinsufflated with a suitable gas, e.g., CO₂ gas, as is conventional andin the art. In one method, a Veress needle may be introduced withinaccess assembly 100 and advanced through longitudinal passage 101 tocause elongated member to unroll from the condition depicted in FIG. 1to the condition depicted in FIG. 2. Thereafter, the Veress needle withmounted access assembly 100 is advanced within the abdominal cavity. TheVeress needle is fluidly coupled to a source of insufflation gases toinsufflate the body cavity. The Veress needle is removed leavingelongated member 110 of access assembly 100 in position accessing thebody cavity. Upon removal of the Veress needle, elongated member 110assumes the coiled or rolled configuration of FIG. 1. In this condition,elongated member 110 is substantially sealed preventing escape of gasesthrough access assembly 100. Thereafter, a surgical instrument isadvanced through longitudinal passage 101 of access assembly 100 causingelongated member to assume the substantially linear condition of FIG. 2.Elongated member 110 establishes a seal about the instrument. FIG. 5illustrates surgical instrument “I” positioned within access assembly100.

Due to its elastomeric characteristics, surgical instrument may beangulated relative to longitudinal axis “y” of seal housing duringperformance of the procedure. The degree of angulation is significantlygreater than inflexible cannula assemblies. FIG. 6 illustrates lateraloffset movement of the surgical instrument. As appreciated, this featurepermits access to tissue remote from access assembly 100 therebypotentially reducing the number of cannula assemblies required toperform the procedure. During angulation, elongated member 110 maintainsa seal about the surgical instrument.

With reference now to FIGS. 5-7, when an endoscopic instrument “I” isinserted into opening 103 of base 102, elongated member 110 unrolls andstretches radially to accommodate instrument “I”. Once received withinelongated member 110, instrument “I” may be manipulated as desired. Thelow profile of base 102 and the configuration of elongated member 110permit instrument “I” to be manipulated to a greater degree than aninstrument inserted through a convention access assembly. The internalsurface of elongated member 110 and/or the external surface ofinstrument “I” may be coated with silicone or other suitable substanceto facilitate insertion and removal of instrument “I” from withinelongated member 110. Removal of instrument “I” causes elongated member110 to return to the initial, pre-stretched condition wherein theelongated member 110 rolls upon itself to create a seal. Access assembly100 may be installed using a veress needle or standard obturator.

Referring now to FIGS. 8-10, an alternate embodiment of an accessassembly according to the present disclosure is shown generally asaccess assembly 200. Access assembly 200 is substantially similar toaccess assembly 100 described hereinabove, and will only be described asrelates to the differences therebetween. Access assembly 200 includes abase 202 and elongated member 210.

With continued reference to FIGS. 8-10, base 202 includes proximal anddistal surfaces 202 a, 202 b and defines opening 203 sized to receive anendoscopic instrument. Opening 203 may includes sloped edges forassisting in receipt of instrument “I” and/or for increasing the rangeof manipulation of endoscopic instrument “I”. Base 202 includes sealingring 205 mounted on distal surface 202 b and about opening 203 formaintaining a seal between the patient and access assembly 200. Base 202may alternately or further include adhesive pads 204 spaced about distalsurface 202 b for selectively securing base 202 to a patient. Base 202further includes suture tie down members 206. Suture tie down members206 may include recesses 208 and/or tabs 209. Recesses 208 are formed inand extend about the perimeter of base 202 and include openings 208 atherein for receiving sutures. In this manner, a surgeon may secureaccess assembly 200 to a patient utilizing sutures placed throughopenings 208 a in recesses 208. Alternatively, suture tie down members206 may include tabs 209. Tabs 209 function in a manner similar torecess 208, permitting a surgeon to secure base 202 to a patient withsutures.

With reference to FIGS. 8 and 10, seal member 210 may include one ormore support members 215 extending the length thereof. Support member215 may include a flexible metal wire, plastic strip or other suitablematerial. Support member 215 is securely attached to elongated member210 and may alternately be integrally formed therewith. Support member215 may be configured to roll elongated member 210 upon itself in theabsences of endoscopic instrument “I” being inserted therethrough. Inthis manner, support member 215 ensures that elongated member 210creates a seal. Support member 215 may further be configured to preventthe inversion of elongated member 210 as endoscopic instrument “I” isremoved from access assembly 200.

Although the illustrative embodiments of the present disclosure havebeen described herein with reference to the accompanying drawings, it isto be understood that the disclosure is not limited to those preciseembodiments, and that various other changes and modifications may beeffected therein by one skilled in the art without departing from thescope or spirit of the disclosure.

1-13. (canceled)
 14. A surgical access assembly, which comprises: anelongated member defining a longitudinal axis and having a longitudinalpassage, the elongated member adapted to transition between a firstcondition upon insertion of a surgical object within the longitudinalpassage and a second rolled condition in the absence of the surgicalobject within the longitudinal passage; and a support member extendingalong at least a longitudinal segment of the elongated member, anddimensioned to provide support to the longitudinal segment.
 15. Thesurgical access assembly according to claim 14 wherein the supportmember is dimensioned to minimize inversion of the longitudinal segmentof the elongated member during removal of the surgical object from thelongitudinal passage of the elongated member.
 16. The surgical accessassembly according to claim 14 wherein the support member includes atleast one of an elongate flexible metal wire or an elongate plasticstrip.
 17. The surgical access assembly according to claim 14 whereinthe support member is secured to the elongated member.
 18. The surgicalaccess assembly according to claim 14 wherein the support member isintegrally formed with the elongated member.
 19. The surgical accessassembly according to claim 14 including multiple support membersextending along the longitudinal segment of the elongated member. 20.The surgical access assembly according to claim 14 wherein the supportmember is dimensioned to facilitate movement of the elongated memberfrom the first condition to the second rolled condition in the absenceof the surgical object within the longitudinal passage.
 21. The surgicalaccess assembly according to claim 14 wherein the elongated member isrolled about an axis extending transverse to the longitudinal axis whenin the second rolled condition.
 22. The surgical access assemblyaccording to claim 14 wherein the elongated member is dimensioned toestablish a sealed relation with the surgical object within thelongitudinal passage.
 23. The surgical access assembly according toclaim 14 wherein the longitudinal passage of the elongated member issealed when in the second rolled condition of the elongated member. 24.The surgical access assembly according to claim 14 wherein thelongitudinal passage of the elongated member is sealed when in the firstcondition of the elongated member and in the absence of the surgicalobject.
 25. The surgical access assembly according to claim 14 whereinthe elongated member is normally biased toward the second rolledcondition.
 26. The surgical access assembly according to claim 14wherein the support member is dimensioned to normally bias the elongatedmember toward the second rolled condition.
 27. The surgical accessassembly according to claim 14 wherein the elongated member compriseselastomeric material and is dimensioned to permit angulated movement ofthe surgical object relative to the longitudinal axis.
 28. The surgicalaccess assembly according to claim 14 including a base connected to theelongated member, the base having an opening for passage of the surgicalobject.
 29. The surgical access assembly according to claim 28 whereinthe base includes one of an adhesive ring or suture tie down members tofacilitate securement of the base relative to a subject.
 30. A surgicalaccess assembly, which comprises: an elongated member defining alongitudinal axis and having a longitudinal passage for reception of asurgical object, the elongated member adapted to transition between afirst condition in the presence of the surgical object within thelongitudinal passage and a second rolled condition in the absence of thesurgical object; and an elongated support member extending along atleast a longitudinal segment of the elongated member, the support memberdimensioned to normally bias the elongated member toward the secondrolled condition.
 31. The surgical access assembly according to claim 30wherein the longitudinal passage of the elongated member is sealed whenthe elongated member is in the second rolled condition.
 32. The surgicalaccess assembly according to claim 30 wherein the longitudinal passageof the elongated member is sealed when the elongated member is in thefirst condition and in the absence of the surgical object.
 33. Thesurgical access assembly according to claim 30 wherein the elongatedmember is dimensioned to establish a seal about the surgical objectreceived within the longitudinal passage.